Hangover Questions Answered

I’m not a big drinker, but I know what a hangover feels like. And this year, millions of people worldwide will partake in celebrating the New Year. That means millions will wake up Jan. 1 with hangovers. According to recent research from the University of Ulster, heavy #alcohol consumption lowers mood, disrupts sleep, increases anxiety and produces physical symptoms, emotional symptoms and fatigue throughout the next morning — as if we didn’t already know. And hangovers have been around since biblical times: “Woe unto them that rise up early in the morning, that they may follow strong drink.” (Isaiah 5:11) Here are the answers to a few questions that might give you a helping hand the next time you have one too many.

What is the definition of a hangover?
According to Jeff Wiese, M.D., a professor of medicine and hangover researcher at Tulane University, there is no consensus on the definition of an alcohol hangover, which is called “veisalgia” (from the Norwegian kveis, or “uneasiness following debauchery,” and the Greek algia, or “pain”). However, most experts have identified a set of common symptoms that can occur after an evening of drinking. These include headache, diarrhea, lack of appetite, tremulousness, fatigue and nausea.

What causes hangovers?
According to Dena Davidson, Ph.D., professor of psychiatry at Indiana University School of Medicine, “Hangovers are caused by several factors, including the direct effects of alcohol (e.g., dehydration, low blood sugar, sleep disturbances), alcohol withdrawal, alcohol metabolism and congeners (compounds found in alcoholic beverages other than alcohol that contribute to their taste, smell and appearance).”

And, according to Dr. Wiese, the greatest impact from a hangover is caused by the activation of inflammation, which may be linked to byproducts of alcohol such as acetaldehyde, or to pollutants found in darker, less-filtered alcohols. Another issue is dehydration, since alcohol impairs your kidneys’ ability to hold onto water. And lastly, says Wiese, “Lack of sleep contributes to the overall symptoms.” That’s right, in spite of what you might believe, alcohol inhibits restful sleep.

How much do you have to drink to get a hangover?
Five to seven cocktails over four to six hours are almost always followed by hangover symptoms. Other factors that influence hangovers are the individual’s drinking level (light, moderate or heavy drinkers — you develop a tolerance if you drink more often) and weight. For instance, women tend to weigh less and have lower percentages of total body water than men, so they are likely to achieve higher degrees of intoxication and, presumably, more hangover per unit of alcohol consumed, adds Wiese.

Can I drink excessively and still prevent a hangover?
Well, you can’t exactly prevent a hangover; however, you can minimize the effects by doing certain things the night before.

Drink fluids: Choose water or #drinks like Gatorade, which replenish the electrolytes — sodium, magnesium and potassium — lost from alcohol consumption. Dr. Wiese recommends drinking liquids such as water between alcoholic drinks. This does not, however, mean drinking alcohol with mixers — that’s not the same.

Eat sugary or starchy foods: The jury is still out whether this helps. However, Dr. Davidson suggests that fruit juice may keep you hydrated and counteract low blood sugar, and that complex carbohydrates such as toast and crackers may counteract nausea and low blood sugar.

Take ibuprofen before you go to bed: Because a hangover is partly due to inflammation, taking aspirin or another type of anti-inflammatory such as ibuprofen (Advil, Motrin, Nuprin, Medipren) helps. “Taking aspirin offsets some of the inflammation, so it can be beneficial — but painkillers can irritate the stomach, and some people just can’t handle that. That’s the only limiting feature,” says Wiese. “The risk for acetaminophen (e.g., Tylenol) is liver disease — and if you’re a heavy drinker, you’re already hurting your liver and should avoid acetaminophen altogether,” adds Davidson.

Don’t drink coffee: One of the causes of a hangover is lack of sleep, and caffeine keeps the brain from deep sleep, in addition to which the diuretic effect further impairs the body’s ability to replenish electrolytes, advises Wiese.

What increases your chances of getting a hangover?

Increasing physical activity while intoxicated: “Vigorous activity works up a sweat, which worsens dehydration — and being drunk often relaxes inhibition to the point where people behave in ways they otherwise wouldn’t,” says Wiese. You can injure yourself if you break into dance moves that you’ve got no business trying to pull off.

Drinking inexpensive or poorly made alcohol and/or darker versus lighter liquors increases your chances of a hangover. According to Davidson, “There is some evidence that alcoholic beverages with fewer congeners (byproducts that vary according to the filtering process used and whether the liquor is clear or colored) are associated with a lower incidence of hangovers than those with more (e.g., brandy, whiskey and red wine).”

Don’t rely on myths: According to Wiese, mixing alcohols (e.g., vodka and gin) or combining alcohol with carbonated beverages has no effect on your potential for developing a hangover. “That’s all myth — mixing alcohol doesn’t make a difference. Nor does carbonation increase the effects of the hangover.” Also, don’t think that if you eat while drinking you decrease your chances of getting drunk and/or a hangover. “The quantity of alcohol you drink is the quantity of alcohol that’s going to be in your stomach. You feel drunk faster when you don’t eat only because the alcohol is absorbed faster, but eventually it’s all going to make its way in no matter what,” says Wiese.

Will anything help cure a hangover?
Not really, but here are a few that have been tested.

Prickly pear extract: This extract from the skin of the Opuntia ficus indica (OFI) plant has a moderate effect on reducing hangover symptoms, apparently by inhibiting the production of inflammatory mediators. One study has shown at least moderate results. “Only three symptoms of nine were reduced: nausea, dry mouth and headache. But the overall hangover doesn’t improve drastically. At this point, it’s not a cure for a hangover. And it requires enough foresight to consume the extract four hours before alcohol — that’s a lot of foresight for most people.” Keep in mind that this was just one study, and although it’s a good one, it was paid for by the makers of the product — Perfect Equation (perfectequation.net).

Vitamin B6: In one study reported in the Quarterly Journal of Studies on Alcohol back in the ’70s, there was a 50 percent reduction in hangover symptoms in participants taking 1,200 milligrams of vitamin B6 (400 milligrams at the beginning of the party, 400 three hours later, and 400 at the party’s conclusion). “We’ve seen very modest benefits for people who take vitamin B6, but I also think that’s probably because they were vitamin B deficient. Also, anyone who urinates frequently loses water-soluble vitamins, and B is one of those. So your body needs more anyway.”

Tolfenamic acid and other nonsteroidal anti-inflammatory drugs such as aspirin offered improvement in subjective symptoms, according to both Wiese and Davidson.

Exercise: “Exercise doesn’t cure a hangover as far as I know,” says Dr. Davidson. However, “you perform at a suboptimal level, which can lead to injury if you choose sports such as skiing,” adds Wiese.

Coffee: Again, you might get a bit of a pick-me-up the next morning; however, the caffeine could cause you to lose water and affect your ability to repair your body.

Propranolol: “The brain is kind of revved up the next day, and propranolol can reduce the adrenaline rush. It decreases hand tremors and anxiety but is probably not effective at reducing headaches, nausea, etc.,” says Wiese. And according to Dr. Davidson, “The evidence for propranolol did not hold up in a controlled trial.”

Quick fixes: There are many products being offered on the Web and at nutrition centers, but most experts agree that these are a waste of money, unless, of course, there is a placebo effect. Even those urban legends such as “Hair of the Dog” or drinking Bloody Mary’s don’t offer much help.

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